Re: Moving India Forward: Prevention and Treament Needs of Sex workers

[Guest guest]

Prevention and Treatment Needs of Sex Workers

Prevention:

The current prevention programs does not address the power relations within the

sex workers communities and outside their communities too. The police is an

important group of people who needs to be constantly addressed at all levels to

be sensitive of this group. There were two stands taken, earlier sex workers

were treated to be the most filthy persons under the category of high risk

behavior and were looked down upon. Now once the epidemic started to flow into

the general public they are considered to be un important. The stand taken for

the treatment of sex workers is like the cat on the wall. Neither the

Government nor the society are ready to think and act rational on the issues of

the sex workers.

The condom use is again very low for two reasons if you go over the system of

economy within the brothels the money spent is mostly on the police and the

other powerful elements within the brothels and the madams are therefore forced

to compensate the loss through their sex workers ( the entire business depends

directly on the sex worker ) which could in most cases include the situations

wherein the sex workers are encouraged or even forced to have unsafe sex, in

which case the client pays extra for having sex without condoms.

The analysis within the above situations are therefore not because the target

groups are unaware of HIV/AIDS transmission, need for consistent condom use

etc. but because of the difference in economy to be met and the way out is to

exploit the sex workers who are in dire need and still continues to be the

victim. Again the sex worker here has no choice but to continue to yield to the

exploitations because if you analyze her quality of life thought you would

realize that unlike the western countries the sex work was not out of choice but

of hard felt situations within their early life that they may have been forced

into the same. Once entered the low self esteem and the fear of stigma forces

them to still continue and go through the entire brunt of the exploitation. This

situation of hers is made use of. The same goes with the children born to them

most often the children are again not of choice but accident. There fore there

are no concrete plans towards the up bringing of the child either.

Again under above situations no amount of negotiating skill towards condom

use work while the situations of matching or balancing the economy within

the trade still persist.

While another situation rises where in when the sex workers are ready for

options especially after she looses her own business with her own body and

had to depend on others majority may be willing for a change. But at that

time there is no option either economic or social. This loss of

sensitivity of the civil society again encourages her to situations of

trafficking and exploitation and the vicious cycle still goes on.

Another major reason for low utilization of condom use depends on the easy

accessibility of condoms. The sex workers even though they are encouraged

to condom use cannot decide to purchase their own condoms. The capacity of

deciding to use the money or may be the money itself is not there for her

to buy the condoms. It is also known that the state AIDS Control Societies

have stopped the free supply of condoms under the mechanism of attaining

sustainability.

This again leads us to analyze the situation in we work in tight

compartments. We do not take issues into consideration and talk of

sustainability of any behavior change depending on solving the issues but

are constantly looking at achieving the ends minus the issues towards the

ends to be met.

2. What are the gaps in care, support and treatment issues?

While we look at care and support services the need spelt out stops not

with the sex worker alone but her family most often consisting of her

existing partner and children. But unfortunately the support services most often

may reach only the sex worker. Most often due to the low literacy level of

the sex worker she is not informed of the services that are available towards

care and support, space to get herself treated is minimum due to the

stigma persisting still. The debts that the sex worker is put into while her

husband or partner dies of HIV/AIDS is an additional burden to her

existing one. Who takes care of it? The stigma is such that it does not

render the space for the children of sex workers to have a quality of life. For

instance AIDS orphans of the society can voice their need out but not a

child of a sex worker.

Even among opportunity treatments the community care center of the

national program does not render space for other testing such as x-rays,

blood tests other than HIV/AIDS, so while that is needed during the OI

treatments the NGO has to supplement their own funds most often if they do not

have then the cases are left behind until unless special efforts are taken,

because if the cases are then taken to a government hospital the patient has to

go through the entire process at the OP again for he or she to take a simple

x-ray or a scan etc. The national program on care and support does not

address support groups or home based care exclusively. provisions are

extremely limited.

The need to comprehensive treatment is absent. Treatment of OIs alone are

considered to be care. It misses out on to the entire spectrum of

comprehensive care such as :

Identification of PLHA through VCT;

Pre and post test counselling rendered;

Psycho social support rendered towards crisis situations;

Rehabilitation incase of disruption due to the impact of HIV/AIDS

situation in the family;

Care of other family members who are dependent - e.g. Children so that

they need not stop their education etc;

Clinical care and treatment of OIs;

Home care;

Pooling in other members of the family to enhance care - e.g. Spouse,

Parents, In-laws etc so as to reduce the burden of the PLHA;

Removing stigma and discrimination by creating an enabling environment

within the family and the community;

Transfer of burden to the family and community at large rather than

institutions; Capacity building of smaller NGOs to take the flow of the entire

spectrum of care series of these who come under them;

Therefore there are some states who run the VCTs attached to either SACS

or Govt. Dept. and hesitate to refer or join with NGOs implementing care and

support services making it equally accessible to all PLHAs.

3. What are the needs of your specific sector to fill these gaps?

- There needs to be interventions and increased sensitization amidst the

police personnel which needs collaborative efforts of the Government and

the NGO sector. The space should not provide opportunities to be used by

the police in terms of money to be thrusted on the sex workers and their

communities.

- There should be increased effort to reduce stigma and discrimination

amidst sex workers which has recently led to displacement and evacuation

of sex workers and in human treatment of the same.

- More importance to the issues, problems and obstacles need to be

addressed primarily than the services themselves. There is no use of

services being in place without the enabling environment created towards the use

of the services.

4. What are your specific suggestions on how civil society can be

brought together at the national and state levels or in a particular area?

The Government Agencies especially the State AIDS Control Societies think

that they can work in isolation which is quite wrong. The Officers and

staff should be exclusively trained of how to work with the civil societies

and

respect the work of the latter. The major part of their work should

consist on how to work along with the NGOs. Currently the situation is

where there is no trust between each other either in terms of work or finance.

The states are registered under societies only to reduce the bureaucracies but

if questioned they still say they are under the chairman or the vice

chairman both of whom are government personnel and every issue has to pass

that many hands. There is a wastage of time over the same.

One way of working could be a trial of having mother NGOs and finance to

the other NGOs could be through the latter wherein then the NGOs would have

larger say. The SACS can be restricted to only monitoring and evaluation

and capacity building to NGOs if they need them. The SACS can also bring

about NGO networking as a major component into the program and render high

level importance in planning and implementation to be only in specific with the

involvement of the target group for who they are working with.

5. What are the major hurdles in working together within civil society?

Suggest strategies wherever you can to overcome these hurdles.

- levels of civil societies are different. networking should start within

the similar groups at the first level and then should be taken forward at

intersectrol collaborations.

- There should be separate funds allotted to every state for civil society

intersectrol collaborations and capacity building for the same.

6. Do you suggest civil society networking at the state or national

level or by area of work or all three?

- any work for that matter should be by area of work, should then start

from the local effort and taken forward to the national effort. for e.g..

care and support should encompass only those who are extensively doing the

same, taken form the district level to the state level and then to the

national level. Most of the components should overcome within the local

level itself.

7. What is the responsibility of the private sector, which is yet to be,

involved actively in HIV/AIDS activities?

The best e.g.. of better results and output would be to involve the

private sector as the chairman of the SACS which then will help reduce

politics and also give a sense of ownership to civil societies and a

change will occur where in there will be better relationships between the

govt. and the NGOs, less bureaucracies, better involvement of self made people,

less red tapiesm, better involvement of private sector within the programs,

better sustainable suggestions and implementation of the same etc.

3. How to move forward with regard to antiretroviral treatment in

government, non-government and private sector?

First lets get there three to work at a level of comfort and tolerance and

get a committed for all three to work for the cause and not look at

individual level of competence. Until that comes about it is hard to go

further.

We need to realize that the ARV should be a joint effort. There needs to

be a separate research where in the identification of funds within the three

sectors needs to spotted out calculated and seen and i am sure that will

be in abundance to serve the needy.

8. What are the unattended critical driving factors of the epidemic,

which we have overlooked?

- major deprivation is overlooking issues with each target group that we

work with - e.g.. sex workers

- we work in tight compartments - e.g. condom use then only within that

sphere

- evaluation - e.g., most bilateral think only on numbers not the process

involved, this will give place for manipulation within the NGO work. NACO

should have control over bilateral in every sphere of work;

- there is a false impression among states SACS that if the number of NGOs

are increased with minimum money then maximum out put would be available

instead it should be minimum NGOs with good capacities to work on a long

term commitment of funding.

- efforts of NGOs are most often overlooked - e.g.. any meeting at the

state level if organized we spend half our time inviting the state govt.

reps

and almost begging them as if they are form heaven and we are the

untouchables.

There should be strict orders that there should be absolute participation

of SACS and they should help NGOs to enhance participation of other Govt.

dept. too.

- There should be specific officers within NACO to be in charge of state

specific SACS for easy approach

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